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CYSTIC FIBROSIS SERVICES, LLC
CAH141319-00 Henry District Hospital
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Covered Entity Details
Entity Name
Henry District Hospital
Subdivision Name
Hammond Henry Hospital
Type
Critical Access Hospital
340B ID
CAH141319-00
Entity Address
600 North College Ave
Geneseo, IL 61254-1099
Medicare Provider Number
141319
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
1/2/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura J Domino, Vice President of Patient Care Services
(309) 944-9101
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/2/2019
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